| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 85 CHESTNUT RIDGE ROAD #214 MONTVALE, NJ 07645 | HCC LIFE INSURANCE COMPANY | $34K | $0 | $34K | 16.14% |
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS | 1540 CORNERSTONE BLVD. DAYTONA BEACH, FL 32117 | HCC LIFE INSURANCE COMPANY | $3K | $0 | $3K | 1.47% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | $0 | $3K | 3.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 85 CHESTNUT RIDGE ROAD #214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE COMPANY | $5K | $0 | $5K | 9.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 W GOLF ROAD 11TH FL ROLLING MEADOWS, IL 60008 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $652 | $652 | 1.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 85 CHESTNUT RIDGE ROAD #214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | $0 | $3K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 W GOLF ROAD 11TH FL ROLLING MEADOWS, IL 60008 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $236 | $236 | 1.25% |
| BORELLA, MATTHEW, LUKE3 Filed as: BORELLA, MATTHEWS, LUKE | 700 KINDERKAMACK ROAD SUITE 205 ORADELL, NJ 07675 | FIRST UNUM LIFE INSURANCE COMPANY | $437 | $0 | $437 | 2.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 85 CHESTNUT RIDGE ROAD #214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE COMPANY | $421 | $0 | $421 | 2.37% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 85 CHESTNUT RIDGE ROAD #214 MONTVALE, NJ 07645 | EYEMED | $1K | $0 | $1K | 10.06% |
| GARY WOOD ASSOCIATES, INC.3 | 1180 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | EYEMED | $92 | $0 | $92 | 0.78% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 85 CHESTNUT RIDGE ROAD #214 MONTVALE, NJ 07645 | FIRST UNUM LIFE INSURANCE COMPANY | $1K | $0 | $1K | 12.71% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 W GOLF ROAD 11TH FL ROLLING MEADOWS, IL 60008 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $76 | $76 | 0.66% |
| WILLIAM RESNICK3 | 85 CHESTNUT RIDGE ROAD #214 MONTVALE, NJ 07645 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $26 | $0 | $26 | — |
| GALLAGHER BENEFIT SERVICES, INC.3 | 85 CHESTNUT RIDGE ROAD #214 MONTVALE, NJ 07645 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $16 | $0 | $16 | — |
| BORELLA, MATTHEW, LUKE3 | 700 KINDERKAMACK ROAD SUITE 205 ORADELL, NJ 07675 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $15 | $0 | $15 | — |
| NEW JERSEY OFFICE, DIRECT BUSINESS3 | 150 JFK PKWY FL 4 SHORT HILLS, NJ 07078 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $0 | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLIED BENEFIT SYSTEMS, INC. EIN 36-3086057 NONE | Claims processing; Plan Administrator Service code 12 | — | $20K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 NONE | Insurance services Service code 23 | — | $20K |
| GALLAGHER BENEFIT SERVICE EIN 36-4291971 NONE | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $18K |
| EXPRESS SCRIPTS, INC EIN 22-3461740 NONE | Claims processing; Contract Administrator Service code 12 | — | $7K |
| DELTA DENTAL EIN 11-1980218 NONE | Contract Administrator; Claims processing Service code 12 | — | $5K |
| BENEFIT RESOURCE, INC. NONE | Contract Administrator; Claims processing Service code 12 | 245 KENNETH DRIVE ROCHESTER, NY 146234277 | $2K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 150 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 21 | $72K |
| Vision | EYEMED | 193 | $12K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 157 | $52K |
| Short-term disability(3 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 75 | $29K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 157 | $52K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 114 | $210K |
| Other(4 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 157 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 193 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.